Abstract
Background and objective: High serum osmolarity has been shown to be lung protective. There is lack of clinical studies evaluating the impact on outcomes such as mortality. We aimed to examine the effect of serum osmolarity on intensive care unit (ICU) mortality in critically ill patients. Methods: Data from January 2000 to December 2012 was accessed using the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation (CORE) database. A total of 509 180 patients were included. Serum osmolarity was calculated from data during the first 24 h of ICU admission. Predefined subgroups (Acute Physiology and Chronic Health Evaluation (APACHE) III diagnostic codes), including patients with acute pulmonary diagnoses, were examined. The effect of serum osmolarity on ICU mortality was assessed with analysis adjusted for illness severity (serum sodium, glucose and urea component removed) and year of admission. Results are presented as OR (95% CI) referenced against a serum osmolarity of 290–295 mmol/L. Results: The ICU mortality was elevated at each extremes of serum osmolarity (U-shaped relationship). A similar relationship was found in various subgroups, with the exception of patients with pulmonary diagnoses in whom ICU mortality was not influenced by high serum osmolarity and was different from other non-pulmonary subgroups (P < 0.01). Any adverse associations with high serum osmolarity in pulmonary patients were confined to patients with a PaO2 /FiO2 ratio > 200. Conclusion: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.
| Original language | English |
|---|---|
| Pages (from-to) | 1165-1170 |
| Number of pages | 6 |
| Journal | Respirology |
| Volume | 22 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Aug 2017 |
Keywords
- Acute Physiology and Chronic Health Evaluation III diagnostic codes
- intensive care unit mortality
- PaO/FiO ratio
- pulmonary patients
- serum osmolarity
Cite this
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ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia. / Bihari, Shailesh; Prakash, Shivesh; Peake, Sandra L.; Bailey, Michael; Pilcher, David; Bersten, Andrew.
In: Respirology, Vol. 22, No. 6, 01.08.2017, p. 1165-1170.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia
AU - Bihari, Shailesh
AU - Prakash, Shivesh
AU - Peake, Sandra L.
AU - Bailey, Michael
AU - Pilcher, David
AU - Bersten, Andrew
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background and objective: High serum osmolarity has been shown to be lung protective. There is lack of clinical studies evaluating the impact on outcomes such as mortality. We aimed to examine the effect of serum osmolarity on intensive care unit (ICU) mortality in critically ill patients. Methods: Data from January 2000 to December 2012 was accessed using the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation (CORE) database. A total of 509 180 patients were included. Serum osmolarity was calculated from data during the first 24 h of ICU admission. Predefined subgroups (Acute Physiology and Chronic Health Evaluation (APACHE) III diagnostic codes), including patients with acute pulmonary diagnoses, were examined. The effect of serum osmolarity on ICU mortality was assessed with analysis adjusted for illness severity (serum sodium, glucose and urea component removed) and year of admission. Results are presented as OR (95% CI) referenced against a serum osmolarity of 290–295 mmol/L. Results: The ICU mortality was elevated at each extremes of serum osmolarity (U-shaped relationship). A similar relationship was found in various subgroups, with the exception of patients with pulmonary diagnoses in whom ICU mortality was not influenced by high serum osmolarity and was different from other non-pulmonary subgroups (P < 0.01). Any adverse associations with high serum osmolarity in pulmonary patients were confined to patients with a PaO2 /FiO2 ratio > 200. Conclusion: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.
AB - Background and objective: High serum osmolarity has been shown to be lung protective. There is lack of clinical studies evaluating the impact on outcomes such as mortality. We aimed to examine the effect of serum osmolarity on intensive care unit (ICU) mortality in critically ill patients. Methods: Data from January 2000 to December 2012 was accessed using the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation (CORE) database. A total of 509 180 patients were included. Serum osmolarity was calculated from data during the first 24 h of ICU admission. Predefined subgroups (Acute Physiology and Chronic Health Evaluation (APACHE) III diagnostic codes), including patients with acute pulmonary diagnoses, were examined. The effect of serum osmolarity on ICU mortality was assessed with analysis adjusted for illness severity (serum sodium, glucose and urea component removed) and year of admission. Results are presented as OR (95% CI) referenced against a serum osmolarity of 290–295 mmol/L. Results: The ICU mortality was elevated at each extremes of serum osmolarity (U-shaped relationship). A similar relationship was found in various subgroups, with the exception of patients with pulmonary diagnoses in whom ICU mortality was not influenced by high serum osmolarity and was different from other non-pulmonary subgroups (P < 0.01). Any adverse associations with high serum osmolarity in pulmonary patients were confined to patients with a PaO2 /FiO2 ratio > 200. Conclusion: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.
KW - Acute Physiology and Chronic Health Evaluation III diagnostic codes
KW - intensive care unit mortality
KW - PaO/FiO ratio
KW - pulmonary patients
KW - serum osmolarity
UR - http://www.scopus.com/inward/record.url?scp=85018609573&partnerID=8YFLogxK
U2 - 10.1111/resp.13055
DO - 10.1111/resp.13055
M3 - Article
VL - 22
SP - 1165
EP - 1170
JO - Respirology
JF - Respirology
SN - 1323-7799
IS - 6
ER -